Abstract
The aim of the study was to improve the results of anterior sacrocolporectopexy, performed for surgical treatment of pelvic posterior compartment prolapse for elimination of its residual manifestations.

Material and Methods: The study group consisted of 18 patients who underwent anterior abdominal sacrocolporectopexy using a synthetic graft due to vaginal apical prolapse and upper rectocele. In the postoperative period, they continued to have complaints about obstructive defecation. When examining these patients in the supine position with digital examination of the rectum in the middle part of the rectovaginal septum a residual rectocele was diagnosed, this was confirmed by x-ray during defecography. Ultrasound showed too proximal location of the graft, namely in the area of the upper third of the rectovaginal septum. At the same time, according to MRI data, the apical prolapse was corrected. These patients were performed additional rectovaginal septum correction with vaginal access using posterior colporrhaphy and anterior levatoroplasty within 2.9 ± 0.5 years. The treatment results were evaluated 12 months after the operation according to clinical data, defecography, ultrasound, MRI, anorectal functional tests on the Polygraf ID apparatus, quality of life assessment.

Results: 12 months after repeated surgical treatment, all patients noted a decrease in symptoms of obstructive defecation, which was confirmed by the results of defecography. So the size of the rectocele decreased from 4.2 ± 0.7 cm to 1.8 ± 0.4 cm (P = 0.003); barium evacuation rate increased from 3.6 ± 0.4 g / s to 5.5 ± 0.5 g / s (P = 0.005); and the percentage remaining after evacuation of barium suspension decreased from 31.2 ± 4.8% to 18.5 ± 4.2% (P = 0.055). Anorectal manometry showed a decrease in the sensitivity threshold from 31.2 ± 3.4 ml to 20.8 ± 3.9 ml (P = 0.053); the volume causing the urge to defecate from 84.2 ± 5.6 ml to 74.5 ± 4.2 ml (P = 0.175); the amplitude of the recto-anal inhibitory reflex with 46.6 ± 5.3 mm Hg up to 34.1 ± 4.9 mm Hg (P = 0.093) and its duration from 27.2 ± 4.5 s to 16.7 ± 2.6 s (P = 0.052). The results of the balloon ejection test also improved, which was positive only in 5 (27.7%) patients before the second operation, after it in all 18 patients.

Conclusions: Thus, as a result of repeated surgery, posterior colporrhaphy and anterior levatoroplasty, in order to eliminate the middle and low rectocele formed after abdominal sacrocolporectopexy due to excessively high graft fixation in the rectovaginal septum, all the anatomical and physiological parameters characterizing the functions of the posterior pelvic floor were normalized. So, posterior colpolorrhaphy and anterior levatoroplasty are adequate and sufficient for the correction of inadequately performed primary surgical procedure in the amount of abdominal sacrocolporectopexy.

Key words: repeated pelvic prolapse, re-surgery, sacrocolporectopexy, posterior colporrhaphy, MRI, defecography, anorectal manometry